Dr. Roach: Over 70? It might be time for a statin
Dear Dr. Roach: I’m a 71-year-old male in reasonably good health. At a recent routine checkup, my primary-care physician suggested I consider taking Lipitor 10 mg. My total cholesterol is in the 150-160 mg/dL range, although my LDL is slightly elevated, and my HDL is slightly low and has been for many years. My usual blood pressure is 130/80, and I have never needed treatment. I have no heart disease or family history of heart disease, am not overweight, exercise regularly and eat a healthy diet.
The only reason my doctor gave me for recommending Lipitor was that I am over 70. He indicated it was up to me, and gave me the impression that, if it were him, he would probably opt not to take it. Is the need to take a statin indicated just based on age? I try to avoid taking medications unless it is clearly necessary.
Dear C.L.: Statin drugs reduce the risk of developing a heart attack. The amount of risk they reduce depends on a person’s baseline risk. Although elevated cholesterol levels and blood pressure are risk factors, being 71 and male is your biggest risk factor.
According to validated calculators (one is at cvriskcalculator.com), your risk of having a heart attack or stroke in the next 10 years is about 19%. Note that your absence of family history, good diet and regular exercise, all important factors, are NOT considered by the calculator, so the 19% is probably an overestimate of the risk in your case.
Treatment with a statin like atorvastatin (Lipitor) would be expected to reduce your risk by 3.5% to 4% over 10 years, to about 15%. Guidelines would clearly recommend a statin drug, such as Lipitor, and most would recommend a high dose, 40 mg or so, rather than the low dose your doctor has suggested.
Guidelines are helpful but not right for everyone. There is not a single decision that is right for everybody, and your preferences really do matter. If you don’t mind taking the medication, it would be a reasonable plan to try it. Most people have no side effects, and the cost for generic atorvastatin is small.
Dear Dr. Roach: I am a 52-year-old woman. I would consider myself in good shape. I do aerobic exercise three to four times a week with weight training. I am 5 feet, 6 inches tall and weigh 119 pounds. I eat a generally healthy diet. I have been noticing that many of my joints crack or crackle (ankles, hips, knees, shoulders, sometimes spine) when I exercise or just with normal activity. Is this normal with aging, or is there something I can do to stop it? Am I doing any joint damage?
Dear A.W.: Cracking joints may be normal, and it’s thought to come from one of two mechanisms. The first is that a tendon can snap over a bony protuberance; the second is that nitrogen bubbles can form under the pressure of moving a joint. Crunching in the joint can be related to debris in the synovial fluid, often seen in arthritis or with damage to the cartilage, such as a torn meniscus in the knee.
One person (thank you, Dr. Donald Unger) did an experiment on himself by cracking the knuckles in only one hand daily for 60 years and found no arthritis in either hand.
An experienced doctor usually can tell the difference between normal and abnormal joints and their noises. An X-ray is occasionally needed.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.